Spotlight on Bladder Cancer

Spotlight on Bladder Cancer

Among Australia’s 15 most common cancers, bladder cancer remains the only one with survival rates that have worsened over the past 30 years. This can mainly be attributed to Australia’s ageing population as the percentage of patients diagnosed with bladder cancer over the age of 80 years has gradually increased. However, if there was not a delay presenting to the doctor, then early identification and referral can lead to timely diagnosis. In addition, the hope is that novel approaches are identified through clinical trials that will help reverse the trend of deteriorating survival rates in bladder cancer.

The bladder is an organ in your pelvis that is part of the urinary system. It works with the kidneys to eliminate the body of waste products from the blood. The bladder has muscular walls that stretch to store urine until it is ready to empty. Urine is liquid waste made by the two kidneys and then carried to the bladder through two tubes called ureters. When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra. Your bladder can hold about 500ml of urine, but you usually feel the need to urinate when it’s holding around 300ml. And just like the urethra, ureters, prostate and renal pelvis, the bladder is lined by a layer of tissue called the urothelium.

Bladder cancer develops when abnormal cells in the lining of the bladder grow and divide in an uncontrolled manner. Cancer that begins in the urothelium of the bladder is much more common than cancer that begins in the urothelium of the urethra, ureters, prostate, or renal pelvis.

Bladder cancer was the11th most commonly diagnosed cancer in Australia in 2020. Last year it was estimated 3098 cases of bladder cancer were diagnosed in Australia (2389 males and 710 females). This is equivalent to an estimated incidence rate of 9.6 cases per 100,000 persons. In addition, it is estimated there were 1016 deaths in Australia from bladder cancer but from 2012 – 2016 on average, 54.3% of people diagnosed with bladder cancer survived 5 years after diagnosis.

Bladder cancer takes different forms:

  • urothelial carcinoma, formally known as transitional cell carcinoma, is the most common form of bladder cancer (80-90%) and starts in the urothelial cells in the bladder wall’s innermost layer
  • squamous cell carcinoma begins in the thin, flat cells that line the bladder
  • adenocarcinoma is a rare form which starts in mucus-producing cells in the bladder.

Bladder cancer may be limited to the lining of the bladder (non-muscle invasive bladder cancer NMIBC), invade the bladder wall (muscle invasive bladder cancer MINC) or spread further to lymph nodes or other organs (advanced or metastatic bladder cancer).

  • The most common symptom of bladder cancer is blood in the urine (haematuria), which usually occurs suddenly and is generally not painful.

    Other less common symptoms include:

    • Problems emptying the bladder;
    • A burning sensation when passing urine;
    • Pain when urinating;
    • Need to pass urine often;
    • Back pain or lower abdominal pain.

Some factors that can increase your risk of bladder and urothelial cancer include:

  • smoking;
  • older age;
  • family history;
  • diabetes treatment using the drug pioglitazone;
  • workplace exposure to certain chemicals used in dyeing in the textile, rubber and petrochemical industries;
  • use of the chemotherapy drug cyclophosphamide;
  • chronic urinary tract infections.

Many times, the best option might include more than one type of treatment. Surgery, alone or with other treatments, is used to treat most bladder cancers. Early-stage bladder cancers can often be removed. But a major concern in people with early-stage bladder cancer is that new cancers often form in other parts of the bladder over time. Taking out the entire bladder 

(called radical cystectomy) is one way to avoid this, but it causes major side effects. If the entire bladder is not removed, other treatments may be used to try to reduce the risk of new cancers. Whether or not other treatments are given, close follow-up is needed to watch for signs of new cancers in the bladder.

Depending on the stage of the cancer and other factors, treatment options can include:

Bladder cancer surgery – type of surgery done depends on the stage of the cancer.

Intravesical therapy – the doctor puts a liquid drug right into your bladder rather than giving it by mouth or injecting it into your blood.

Chemotherapy – it can be given in 2 different ways, either straight into the bladder or given in pill form or injected into a vein or muscle. The drugs then go into the bloodstream and travel throughout the body.

Radiation therapy – uses high-energy radiation to kill cancer cells.

Immunotherapy – is the use of medicines to help a person’s own immune system recognise and destroy cancer cells.

Targeted therapy – as researchers have learned more about the changes inside cells that cause cancer, they have developed newer drugs that target some of these changes. These targeted drugs work differently from other types of treatment, such as chemotherapy, and they may work in some cases when other treatments don’t.

Several ground-breaking bladder cancer trials using some of the therapies listed above, are currently underway in Australia.